Hormonal Contraception as Treatment for Heavy Menstrual Bleeding

Uhm, Suji; Perriera, Lisa

doi:10.1097/grf.0000000000000061

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…Moreover, LNG‐IUDs are more effective at reducing heavy blood loss compared with oral treatments, including combined oral contraceptives, non‐steroidal anti‐inflammatory drugs and oral progestogen regimens 7 . ‐ 10 There is currently insufficient evidence to demonstrate significant differences in quality of life or patient satisfaction between these management options, but continuation rates at 12 months appear to be almost 80% for women with heavy menstrual bleeding and 96% for women with leiomyomas, suggesting that this treatment is well tolerated 4…”

Section: Primary Endometrial Dysfunctionmentioning

confidence: 99%

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Brennan

Hickey

2018

Medical Journal of Australia

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Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

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Section: Primary Endometrial Dysfunctionmentioning

confidence: 99%

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Brennan

Hickey

2018

Medical Journal of Australia

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“…Combined estrogen and progestogen Combined contraceptives (CCs) containing estrogen and progestogen reduce menstrual blood loss by 35 to 72%, and are a therapeutic option for most causes of AUB without structural change. [23][24][25] (D, A, A) Combined monophasic contraceptives are generally used in cyclic schedules with pauses, but can also be administered continuously, and reduce the number of menstruation episodes. Literature studies are more frequent with formulations containing 30 mcg of ethinyl estradiol associated with levonorgestrel, but theoretically various formulations may be used.…”

Section: Hormone Treatmentmentioning

confidence: 99%

Abnormal Uterine Bleeding

2015

Ultrasound in Medicine & Biology

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Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormal uterine bleeding, both acute and chronic. Didactically, the treatment options were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and the latter is based mainly on hormonal therapy, anti-inflammatory drugs and antifibrinolytics. Ã This revision is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia-FEBRASGO, elaborated by the Specialized National Committees in Endocrine Gynecology.

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“…(1,2) It affects onethird of women of reproductive age and is the most common reason for gynecological consultation. (1,3,4) Drug therapy is the initial approach, with the recommendation of hormonal and non-hormonal drugs; however, this treatment only results in a 40%-50% reduction in menstrual blood loss. (5) einstein (São Paulo).…”

Section: ❚ Introductionmentioning

confidence: 99%

“…(6) The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective alternative to heavy menstrual bleeding and has been increasingly used. (1)(2)(3)5,(7)(8)(9)(10)(11) In cases of heavy menstrual bleeding without a structural cause, there was a reduction of 86% after three months and 97% after 12 months. (5,12) In 1999, a kidney transplant patient with multiple fibroids, treated with LNG-IUS due to contraindication to surgery, developed reduced bleeding, and paved the way for a new perspective of clinical treatment in these cases.…”

Section: ❚ Introductionmentioning

confidence: 99%

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Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri

Depes¹,

Mata²,

Pereira³

et al. 2023

Einstein (São Paulo)

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Objective: To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods: This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2. Results: In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00). Conclusion: Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.

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Hormonal Contraception as Treatment for Heavy Menstrual Bleeding

Cited by 16 publications

References 26 publications

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Abnormal Uterine Bleeding

Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri

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